Healthcare Provider Details

I. General information

NPI: 1093738106
Provider Name (Legal Business Name): ROBERT L FLINT DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST SUITE 550
LOUISVILLE KY
40202-5700
US

IV. Provider business mailing address

501 S PRESTON ST
LOUISVILLE KY
40202-1701
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5401
  • Fax: 502-852-7602
Mailing address:
  • Phone: 502-852-5401
  • Fax: 502-852-7602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number30494
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6449/978
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: